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HTN (treatment (lifestyle (low salt diet 3-6g/day, reduce caffeine intake,…
HTN
treatment
medical
less than 55 years
Start with ACEi
add CCB
add thiazide diuretic (chlorthalidone)
K <=4.5 add spironolactone
K>=4.5 add high dose of thiazide-like Rx
over or at 55 y or afro-carribean
start with CCB
add ACEi
add thiazide diuretic
#
(chlorthalidone)
lifestyle
low salt diet 3-6g/day
reduce caffeine intake
smoking cessation
less alcohol
balanced diet
exercise
weight loss
target
less than 80
140/90
more than 80
150/90
ancillary
bloods
U+Es
HbA1c
lipids
ECG
urine dipstick
aetiology
secondary
primary hyperaldosteronism
Conn's syndrome
renal disease
glomerulonephritis
pyelonephritis
polycystic kidney disease
renal artery stenosis
endocrine
phaechromocytoma
cushing's syndrome
liddle's syndrome
congenital adrenal hyperplasia
acromegaly
other
NSAIDs
pregnancy
coarctation
COC
steroids
MAOI
primary
clinical
symptoms
asymptomatic
signs
fundoscopy
urine dipstick
ECG
LVH
/bp
diagnosis
clinic reading >= 140/90
offer ABPM or HBPM
less than 135/88
not hypertensive - monitor
greater than 135/85
stage 1 HTN
treat if >80 and
target organ damage
established CVD
renal disease
diabetes
diabetes
10-year CVD risk >= 20%
greater than 150/95
stage 2 HTN
treat all patients regardless of age